Table 8.

Determinants of health system resilience during COVID-19.

Determinant	Excess Mortality Reduction (per 100,000)	Service Disruption Reduction (Months)	Recovery Speed (Months to Baseline)	RIC (%)
Pre-pandemic Preparedness
IHR Core Capacity Score	24.3*** (6.2)	1.8*** (0.4)	2.4*** (0.6)	28.7
Health Workforce Density	18.7*** (5.1)	1.2*** (0.3)	1.9*** (0.5)	22.4
Surge Capacity Beds	12.4** (4.8)	0.8** (0.3)	1.2** (0.4)	14.6
Health System Architecture
Primary Care Strength	16.2*** (5.4)	1.4*** (0.4)	2.1*** (0.5)	19.8
Integrated Service Delivery	14.8*** (5.0)	1.1*** (0.3)	1.8*** (0.5)	17.5
Digital Health Infrastructure	21.5*** (5.8)	2.3*** (0.5)	2.7*** (0.6)	25.3
Governance & Coordination
Policy Coherence	19.6*** (5.5)	1.6*** (0.4)	2.2*** (0.5)	23.1
Decentralized Response	15.3*** (5.2)	1.3*** (0.4)	1.9*** (0.5)	18.2
Community Engagement	13.7*** (4.9)	1.5*** (0.4)	2.0*** (0.5)	16.9
Financial Protection
Health Insurance Coverage	11.2** (4.7)	0.9** (0.3)	1.4** (0.4)	13.4
Budget Flexibility	9.8** (4.5)	0.7** (0.3)	1.1** (0.4)	11.7
Supply Chain Resilience
Local Production Capacity	8.6* (4.2)	0.6* (0.3)	0.9* (0.4)	10.2
Stockpile Management	7.9* (4.1)	0.5* (0.3)	0.8* (0.4)	9.4
Model Statistics
R-squared	0.72	0.68	0.65	-
Countries	135	135	135	-
Observations	135	135	135	-

Source: Author’s analysis of COVID-19 impact data. Dependent variables: Excess mortality (COVID-19 deaths minus expected deaths), service disruption (months of >25% reduction in essential services), recovery speed (months to return to pre-pandemic service levels). Resilience Index Contribution, standardized coefficient as percentage of total explained variance. All models control for COVID-19 incidence, population age structure, and GDP per capital.

^*p < 0.1.

^**p < 0.05.

^***p < 0.01.